Anti-Neoplastics

Hannah Sto. Domingo RN MAN

Cancer (Carcinoma)
• Characterized by rapid, uncontrolled cell
division
• Cells lose normal functions and invade
normal tissues
• Metastasis: cancer cells travel to another
location

Invasion and metastasis by cancer cells

Table 38.1 Classification and Naming of Tumors
Name Description Examples
Benign tumor Slow growing; does not metastasize and rarely Adenoma, papilloma and lipoma,
requires drug treatment osteoma, meningioma
Carcinoma Cancer of epithelial tissue; most common type Malignant melanoma, squamous cell
cancer of malignant neoplasm; grows rapidly and carcinoma, renal cancer,
metastasizes adenocarcinoma, hepatocellular
carcinoma
Glioma Cancer of glial (interstitial) cells in the central Telangiectatic glioma, brainstem glioma
nervous system
Leukemia Cancer of the blood-forming cells in bone Myelocytic leukemia, lymphocytic
marrow; may be acute or chronic leukemia
Lymphoma Cancer of lymphoid tissue Hodgkin disease, lymphoblastic
lymphoma
Malignant Grows rapidly, becomes resistant to treatment, Malignant melanoma
tumor and results in death if untreated
Sarcoma Cancer of connective tissue; grows extremely Osteogenic sarcoma, fibrosarcoma,
rapidly and metastasizes early in the progression Kaposi sarcoma, angiosarcoma
of the disease
Causes of Cancer
• Some known carcinogens • Biological
• Chemical • Viruses (associated with 15% of all
• Tobacco (responsible for one third of cancers)
all cancers) • Examples: herpes simplex viruses,
• Asbestos (lung cancer) Epstein–Barr, papillomavirus,
cytomegalovirus
• Benzene (leukemia)
• Factors that suppress immune system
• Physical
• HIV
• X-rays (leukemia)
• Drugs given after transplants
• Ultraviolet (UV) light from sun (skin
cancer) • Oncogenes (genetic predisposition)
• Damage to tumor suppressor gene
 Environmental and Lifestyle Factors
• Many associated with higher risk of cancer
• Encourage patients to adopt healthy lifestyle habits
• Eliminate use of and exposure to tobacco
• Limit alcohol use
• Eat healthy diet (low in fat, high in fruits and vegetables)
• Choose most foods from plant sources
• Exercise regularly; keep weight normal
• Use protection from sun
• Self-examine body monthly for abnormal lumps and skin lesions
Lifestyle Factors Regarding Prevention and Diagnosis
• Get periodic screenings
• Mammogram
• Prostate exam
• Fecal occult blood test
• Colonoscopy
• Pap test and pelvic exam
Treatment of Cancer
• Drug therapy (chemotherapy)
• To cure
• For palliation
• For prophylaxis
• Surgery
• Radiation therapy
Chemotherapy
• Transported through blood
• Has potential to reach each cancer cell
• Some drugs can cross blood–brain barrier
• Some drugs distilled directly into body cavities (e.g., bladder)
Surgery
• Performed to remove tumor
• When localized
• When pressing on nerves, airways, or other vital tissues
• Surgery sometimes not an option
• If tumors affect blood cells
• If surgery would not extend lifespan or improve quality of life
Radiation
• Can destroy tumor cells
• Ionizing radiation aimed directly at tumor
• May follow surgery
• Used as palliation for inoperable cancers
• Shrinks size of tumor
• Relieves pain, difficulty breathing or swallowing
Adjuvant Chemotherapy
• Often combined with or done after surgery and radiation to
increase chance of cure
• May be given as chemoprophylaxis to prevent cancer in high-
risk patients
• Tamoxifen to prevent recurrent breast cancer
Cell Cycle
• Cell cycle
• G0 phase: resting stage
• G1 phase: synthesizes material needed to
duplicate D N A
• S phase: Duplicates D N A
• G2 phase: Premitotic phase, cell makes important
proteins to be used in cell division and in normal
physiologic functioning
• M phase: Mitosis occurs
• Cell returns to G0 phase
 Figure 38.2
Antineoplastic drugs and the cell cycle
Achieving Total Cure
• Total cure = every malignant cell removed or killed
• Even one cell could reproduce
• Immune system eliminates very small number of cancer cells
• Important to diagnose cancer early
• Treat with surgery, radiation, chemotherapy
Multiple-Drug Strategy
• Multiple drugs from different classes
• Affect different stages in cell cycle
• Use different mechanisms of action to increase cell kill
• Combinations allow for lower doses
• Reduce toxicity
• Slow development of resistance
Dosing Schedules
• Specific dosing protocols
• Depend on type of tumor, stage of disease, overall condition of patient
• May be given as single dose or several doses
• May be given within days or after several weeks
• Gives normal cells chance to recover
• Sometimes optimal dose must be delayed
• Lets patient recover from drug toxicities
• Example: in bone marrow depression
Antineoplastics
• Kill or inhibit the reproduction of neoplastic cells
• Used to cure, increase survival time, and decrease life threatening complications
• Effect may not be limited to neoplastic cells → normal cells are also affected
• CELL CYCLE PHASE-SPECIFIC medications affect cells only during a certain phase of the
reproductive cycle
• CELL CYCLE PHASE-NON SPECIFIC medications affect cells in any phase of the
reproductive cycle
• Several medications are used in combination to increase the therapeutic response
• May be combined with other treatments such as surgery and radiation
• IV route is more common but may also be given PO, SC, intraarterial, isolated limb
perfusion, or intracavity route
• Dosing is based on the client’s BSA and type of cancer
• Requires current, accurate height and weight before each medication administration
to ensure that the client receives optimal doses of chemotherapy medications
Antineoplastics
• Side and adverse effects
• Mucositis
• Alopecia
• Anorexia, nausea, and vomiting
• Diarrhea
• Anemia
• Low WBC count
• Thrombocytopenia
• Infertility, sexual alterations
• Neuropathy
Antineoplastics
• General Interventions
• PHYSIOLOGICAL INTEGRITY
• Monitor CBC count, WBC count, platelet count, uric acid level, and electrolytes
• Initiate bleeding precautions if with thrombocytopenia (may need to withhold medication)
• Monitor for petechiae, ecchymoses, bleeding of the gums, and nosebleeds
• Avoid IM injections and venipunctures to prevent bleeding
• Initiate neutropenic precautions
• Monitor for fever, sore throat, unusual bleeding, and s/sx of infection
• Inform client that loss of appetite also may be the result of taste changes or a bitter taste in the
mouth from the medications
• Monitor for nausea and vomiting and provide a high calorie diet with protein supplements
• Administer antiemetics prior chemotherapy as medications stimulate the vomiting center in
the brain
• Encourage hydration: IV fluids are given before and during therapy
• Promote fluid intake of at least 2000mL/day to maintain adequate renal function
Antineoplastics
• General Interventions
• SAFE AND EFFECTIVE CARE ENVIRONMENT
• Prepare IV chemotherapy in an air-vented space (biological safety cabinet)
• Wear appropriate PPE to reduce exposure whenever there is a risk of hazardous
medications being released into the environment )gloves, gown, mask, eye protector)
• Pregnant nurses should avoid each chemotherapy preparation and administration
• Discard IV eqpt in designated containers
• Administer medication precisely as prescribed to maximize effects while allowing
normal cells to recover
• Monitor for phlebitis with IV administration
• Vesicants should be administered through a central line when possible; check for
blood return in peripheral line is accessed before administration
• Reduce IV site pain by altering IV rates or warming the injection site to distend vein
and promote blood flow
• Monitor for extravasation and notify HCP if this occurs
Antineoplastics
• General Interventions
• PSYCHOSOCIAL INTEGRITY
• Instruct client about the possibility of hair loss and that varying degrees of hair
loss may occur after the first or second treatment
• Discuss purchase of a wig before treatment starts and consider cutting the hair
short
• Inform client that the new hair growth will occur several months after the final
treatment
• Instruct client about the need for contraception as medications are teratogenic
• Discuss potential side effect of infertility, which may be irreversible
• Encourage pretreatment counseling and sperm banking or preservation of eggs
if the client is still of childbearing age
Antineoplastics
• General Interventions
• HEALTH PROMOTION AND MAINTENANCE INSTRUCTIONS
• Avoid spicy foods and other gastric irritants that increase peristalsis if diarrhea persists
• Inspect the oral mucosa frequently for erythema and ulcers, rinse mouth after meals,
and carry out good oral hygiene
• Use mouth rinses as prescribed for mouth sores if necessary (i.e antifungal agents,
alcohol free rinses)
• Avoid crowds and persons with infections and to report signs of infection i.e. low grade
fever, chills, or sore throat
• Instruct individuals with colds or infections to wear a mask when visiting or to avoid
vising the client
• Use a soft toothbrush and electric razor to minimize the risk of bleeding
• Avoid aspirin-containing products to minimize the risk of bleeding
• Consult HCP before receiving vaccinations (i.e live vaccines)
Antineoplastics
• Anaphylactic reactions • S/sx
• Precautions • Dyspnea, chest tightness or pain
• Allergy history • Pruritus or urticaria
• Test dose • Tachycardia
• Stay with the patient • Dizziness
• Monitor vital signs • Anxiety or agitation
• Have emergency eqpt and • Flushed appearance
medications readily available • Hypotension
• Obtain IV access for administration • Decreased sensorium
of emergency medications if • cyanosis
needed
Antineoplastics
• Cell Cycle Nonspecific
• Alkylating agents
• Antitumor antibiotics
• Hormonal therapy

• Cell Cycle Specific

• Antimetabolic agents → affect S phase
• Mitotic inhibitors → affect M phase
• Topoisomerase inhibitors → affect G2 and S phase
Alkylating Agents
NITROGEN MUSTARDS NITROSUREAS ALKYLATING-LIKE
• Bendamustine • Carmustine MEDICATIONS
• Chlorambucil • Lomustine • Altretamine
• Cyclophosphamide • Streptozocin • Busulfan
• Ifosfamide • Carboplatin
• Estramustine • Cisplatin
• Mechlorethamine • Dacarbazine
• Melphalan • Oxaliplatin
• Temozolomide
• Thiotepa
Alkylating Agents
• Break the DNA helix, interfering with DNA replication
• WOF
• Anorexia, nausea, and vomiting
• Stomatitis
• Rashes
• IV site pain
• Busulfan may cause hyperuricemia
• Chlorambucil and mechlorethamine may cause gonadal suppression and hyperuricemia
• Cisplatin (platinum compound) may cause ototoxicity, tinnitus, hypokalemia,
hypocalcemia, hypomagnesemia, and nephrotoxicity
• Cyclophospamide may cause alopecia, gonadal suppression, hemorrhagic cystitis, and
hematuria
• Ifosfamide may cause neurotoxicty
Alkylating Agents
• Other interventions
• Assess results of pulmonary function tests, renal and liver function studies
• Assess for side and adverse effects
• Cyclophosphamide is administered without food if given orally
• Follow a diet low in purines to alkalinize the urine and lower uric acid blood levels
• Avoid infection
• Report signs of infection and bleeding
• Reinforce importance of good oral hygiene and use of a soft toothbrush
• Increase fluid intake during therapy unless contraindicated (2-3 L/day)
• Cyclophosphamide and ifosfamide may cause hemorrhagic cystitis
Antitumor Antibiotic Medications
• Bleomycin sulfate
• Dactinomycin
• Daunorubicin
• Doxorubicin
• Epirubicin
• Idarubicin
• Mitomycin
• Mitoxantrone
• Valrubicin
Antitumor Antibiotic Medications
• Interfere with DNA and RNA synthesis
• WOF
• Nausea and vomiting
• Fever
• Bone marrow depression
• Rash
• Alopecia
• Stomatitis
• Gonadal suppression
• Hyperuricemia
• Vesication
• Daunorubicin may cause heart failure and dysrhythmias
• Doxorubicin and idarubicin may cause cardiotoxicity, cardiomyopathy, and
electrocardiographic changes
• Bleomycin may cause pulmonary toxicity
Antitumor Antibiotic Medications
• Other interventions
• Assess results of pulmonary function tests
• Monitor for electrocardiography changes
• Assess lung sounds for crackles
• Assess for signs of heart failure i.e. dyspnea, crackles, peripheral edema, and
weight gain
• Assess results of chest radiography, renal and liver function studies
• Assess for myocardial toxicity
Antimetabolite Medications
• Azacitidine • Hydroxyurea
• Capecitabine • Mercaptopurine
• Cladribine • Methotrexate
• Clofarabine • Nelarabine
• Cytarabine • Pemetrexed
• Decitabine • Pentostatin
• Floxuridine • Pralatrexate
• Fludarabine • Thioguanine
• Fluorouracil • Uracil
• Gemcitabine
Antimetabolite Medications
• Halt the synthesis of cell protein
• WOF
• Anorexia, nausea, and vomiting
• Diarrhea
• Alopecia
• Stomatitis
• Bone marrow depression
• Cytarabine may cause alopecia, stomatitis, hyperuricemia, and hepatotoxicity
• Fluorouracil may cause alopecia, stomatitis, diarrhea, phototoxicity reactions, and
cerebral dysfunctions
• Methotrexate may cause alopecia, stomatitis, hyperuricemia, photosensitivity,
hepatotoxicity and hematologic, GI, and skin toxicity
Antimetabolite Medications
• Other interventions
• Monitor renal function studies
• Monitor for cerebellar dysfunction
• Assess for photosensitivity
• When administering fluorouracil, assess for signs of cerebellar dysfunction i.e.
dizziness, weakness, ataxia, and assess for stomatitis and diarrhea
• Instruct client to use sunscreen and wear protective clothing to prevent
photosensitivity reactions (fluorouracil or methotrexate)
Mitotic Inhibitor Medications
• VINCA ALKALOIDS
• Vinblastine sulfate
• Vincristine sulfate
• Vinorelbine

• TAXANES
• Docetaxel
• Paclitaxel
Mitotic Inhibitor Medications
• Prevent mitosis causing cell death
• WOF
• Leukopenia
• Neurotoxicity with vincristine (numbness and tingling in the fingers and toes, constipation,
and paralytic ileus)
• Ptosis
• Hoarseness
• Motor instability
• Anorexia, nausea, and vomiting
• Peripheral neuropathy
• Alopecia
• Stomatitis
• Hyperuricemia
• Phlebitis at IV site
Mitotic Inhibitor Medications
• Other interventions
• Monitor for side and adverse effects
• Initiate safety precautions
Topoisomerase Inhibitors
• ETOPOSIDE
• IRINOTECAN
• TENIPOSIDE
• TOPOTECAN
Topoisomerase Inhibitors
• Block an enzyme needed for DNA synthesis and cell division
• WOF
• Leukopenia, thrombocytopenia, anemia
• Anorexia, nausea, and vomiting
• Diarrhea
• Alopecia
• Orthostatic hypotension
• Hypersensitivity reaction
Hormonal Medications and Enzymes
ESTROGENS ANTIANDROGENS OTHERS
• Estramustine • Bicalutamide • Asparaginase
• Ethinyl estradiol • Flutamide • Leuprolide acetate
• Goserelin acetate • Mitotane
ANTIESTROGENS • Histrelin
• Anastrozole • Nilutamide
• Exemestane • Triptorelin
• Fulvestrant
• Letrozole PROGESTIN
• Raloxifene • Medroxyprogesterone
• Tamoxifen citrate • Megestrol acetate
• Toremifene
Hormonal Medications and Enzymes
• Suppress the immune system and block normal hormones in hormone-sensitive tumors
• Change the hormonal balance and slow the growth rates of certain tumors
• WOF
• Anorexia, nausea, and vomiting
• Leukopenia
• Impaired pancreatic function with asparaginase
• Sex characteristic alterations
• Masculinizing effect in women: chest and facial hair, menses stop
• Feminine manifestations in men: gynecomastia
• Breast swelling
• Hot flashes
• Weight gain and edema
• Thromboembolic disorders
• Electrolyte imbalances
• Hypertension
• Hypercholesterolemia (i.e Tamoxifen)
• Decreases effects of estrogen (i.e Tamoxifen)
Hormonal Medications and Enzymes
• Other interventions
• Assess medications that the client is taking currently
• Monitor serum calcium levels with androgens
• Monitor for signs of alterations in sexual characteristics
• Monitor pancreatic function with asparaginase
• Monitor uric acid and cholesterol levels
• Monitor for signs of hemorrhagic cystitis
Immunomodulator Agents: Biological Response Modifiers
• Stimulate the immune system to recognize cancer cells and take action to eliminate or
destroy them
• Interleukins help various immune system cells to recognize and destroy abnormal
body cells
• Interferons slow tumor cell division, stimulate proliferation, and cause cancer cells to
differentiate into nonproliferative forms
 Immunomodulator Agents: Biological Response Modifiers
• Aldesleukin COMMON MONOCLONAL SMALL MOLECULE INHIBITORS
• Interferon alfa-2a ANTIBODIES • Bortezomib
• Interferon alfa-2b • Bevacizumab • Dasatinib
• Interferon alfa-n3 • Cetuximab • Erlotinib
• Recombinant interferon alfa-2a • Ibritumomab • Gefitinib
• Recombinant interferon alfa-2b • Infliximab • Imatinib
• Panitumumab • Lapatinib
• Rituximab • Nilotinib
• Trastuzumab • Sorafenib
• Sunitinib
• Temsirolimus
Immunomodulator Agents: Biological Response Modifiers
• COLONY STIMULATING FACTORS
• Induce more rapid bone marrow recovery after suppression by chemotherapy
• Granulocyte-Macrophage Colony-Stimulating Factor
• Sargramostim
• Granulocyte Colony-Stimulating Factor
• Filgrastim
• Pegfilgrastim
• Erythropoietin
• Epoetin alfa
• Darbepoetin alfa
• Thrombopoietic Growth Factor
• Oprelvekin
References
• Adams, M., et al. (2020). Pharmacology for Nurses: A Pathophysiologic
Approach. 6th ed. Pearson.

• Karch, A. (2019). Focus on Nursing Pharmacology. 8th ed. Wolters Kluwer.

• Kee, J., et al. (2018). Pharmacology: A Patient-Centered Nursing Process

Approach. 9th ed. Elsevier.

• McFadden, R. (2019). Introducing Pharmacology for Nursing and

Healthcare. 3rd ed. Routledge.

• Skidmore-Roth. L. (2020). Mosby’s Drug Guide for Nursing Students with

2020 Update. 13th ed. Elsevier.